Original Article
Survey About the Use of Lung Function Testing in Public Hospitals in Catalonia in 2009
Encuesta de utilización de la función pulmonar en los hospitales públicos de Cataluña en 2009
Nuria Rogera,
, Felip Burgosb, Jordi Ginerc, Alba Rosasd, Ricard Tresserrase, Joan Escarrabillf, the Lung Function Group of the Plan Director de las Enfermedades del Aparato Respiratorio (PDMAR) ◊
Corresponding author
a Direcció d’Especialitats Mèdiques, Consorci Hospitalari de Vic, Vic, Barcelona, Spain
b Institut del Tòrax, Hospital Clínic, Barcelona, Spain
c Servei de Pneumologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
d Direcció General de Regulació, Planificació i Avaluació, Departament de Salut, Barcelona, Spain
e Direcció General de Regulació, Planificació i Recursos Sanitaris, Departament de Salut, Barcelona, Spain
f Agència d’informació, Avaluació i Qualitat en Salut (AIAQS) i Observatori TRD & Pla Director de les Malalties de l’Aparell Respiratori (PDMAR), Barcelona, Spain
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Se representan las tasas de espirometrías por centro para toda Cataluña y por región sanitaria en escala logarítmica y centradas en la media para mejorar su comparabilidad. Cada punto representa un centro hospitalario.</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Bcn: región sanitaria Barcelona; Cat: total Cataluña; Centre: región sanitaria Centro; Ebre: región sanitaria Terres de l’Ebre; Girona: región sanitaria Girona; Lleida: región sanitaria Lleida; Piri: región sanitaria Alt Pirineu; Tarra: región sanitaria Tarragona.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nuria Roger, Felip Burgos, Jordi Giner, Alba Rosas, Ricard Tresserras, Joan Escarrabill" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Nuria" "apellidos" => "Roger" ] 1 => array:2 [ "nombre" => "Felip" "apellidos" => "Burgos" ] 2 => array:2 [ "nombre" => "Jordi" "apellidos" => "Giner" ] 3 => array:2 [ "nombre" => "Alba" "apellidos" => "Rosas" ] 4 => array:2 [ "nombre" => "Ricard" "apellidos" => "Tresserras" ] 5 => array:2 [ "nombre" => "Joan" "apellidos" => "Escarrabill" ] 6 => array:1 [ "colaborador" => "el grupo de trabajo de Función 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"identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Institut del Tòrax, Hospital Clínic, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servei de Pneumologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Direcció General de Regulació, Planificació i Avaluació, Departament de Salut, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Direcció General de Regulació, Planificació i Recursos Sanitaris, Departament de Salut, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Agència d’informació, Avaluació i Qualitat en Salut (AIAQS) i Observatori TRD & Pla Director de les Malalties de l’Aparell Respiratori (PDMAR), Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Encuesta de utilización de la función pulmonar en los hospitales públicos de Cataluña en 2009" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2605 "Ancho" => 3333 "Tamanyo" => 767773 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Spirometry rates per 100 inhabitants in the Barcelona healthcare region.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Respiratory diseases are the third leading cause of death in developed countries,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and the impact on the healthcare system is very high. In Catalonia (Spain), respiratory diseases lead to 10% of hospital admissions, 20% of which are related to chronic obstructive pulmonary disease (COPD).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The incidence of COPD in subjects over the age of 40 years is around 10%.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> COPD exacerbation is a major health problem, due to the high risk for patients in terms of survival, and frequent exacerbations increase mortality.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Mortality during admission is 6.7% and one-year mortality after the onset of exacerbation is 33%,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> although in Catalonia, Almagro et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> reported a mortality of 22% with a high percentage of re-admissions. Thirty-eight percent (38%) of patients are readmitted within the year and the mean time from discharge to readmission is 5 months.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Underdiagnosis is one of the most serious issues in the management of respiratory diseases and COPD in particular,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> a problem that has remained constant over the years. Only one third of COPD patients are aware that they have this disease<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and 21% of patients admitted due to COPD exacerbation state that they are not regularly seen by a doctor for their respiratory problem.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In addition to underdiagnosis, the percentage of misdiagnoses must also be considered.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13</span></a> Pellicer Císcar et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> observed that even in the hospital setting, the failure to perform spirometry testing is the most important factor in explaining the misdiagnosis of COPD. Compared to patients with chronic heart failure, COPD patients have much lower chance of having confirmatory tests, even if both conditions co-exist.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15,16</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Reducing underdiagnosis and obtaining the correct diagnosis require specific procedures, but the most important is to guarantee access to quality spirometry.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,18</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">One of the major challenges facing all healthcare systems consists of identifying the most appropriate strategies for establishing priorities and implementing decisions in the front line of care.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19,20</span></a> The Department of Health of the <span class="elsevierStyleItalic">Generalitat de Catalunya</span> uses their Master Plans<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> for bringing strategic planning to the operative plans, with the aim of improving patient care. One of the objectives of the Respiratory Diseases Master Plan (PDMAR) is to guarantee that the clinician has access to quality spirometry, regardless of the healthcare setting in which he/she works. In this context, the aim of this study was to determine the use of spirometry in hospitals of the Catalonia public health system, and to highlight any possible deficits, areas for improvement and possible regional imbalances in lung function studies, particularly spirometry.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Materials and Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This study was carried out within the framework of the public hospital network of Catalonia. The public health system of Catalonia is a national healthcare system which guarantees cover for the entire population, financed by public taxes. The patient does not have to make any payment at the time of receiving care. The services are financed by the Catalan Healthcare Service (CatSalut), which purchases services from different suppliers. The survey was distributed among the hospital network (XHUP) with which CatSalut has contracted service provision. These suppliers, both privately and publicly owned, make up the network of hospitals for public use and constitute the greatest part of the total healthcare network of Catalonia.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Survey</span><p id="par0030" class="elsevierStylePara elsevierViewall">A cross-sectional study was conducted using a survey distributed to the 65 hospitals of the Catalan public network during the first quarter of 2009 (<a class="elsevierStyleCrossRef" href="#sec0095">Appendix 1</a>). The surveys were distributed via the hospital administration departments, who designated a contact person in the Respiratory Medicine departments who could provide additional responses and information if necessary. The results were collected between April and June 2009. A maximum of three attempts were made to obtain the data, with a telephone reminder after the second attempt.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Data</span><p id="par0035" class="elsevierStylePara elsevierViewall">The survey collected information on the activity of the hospital, lung function tests that were performed in each hospital, whether basic (forced spirometry) or complex (lung volumes, carbon monoxide diffusing capacity, arterial blood gases), number of spirometries carried out in the previous year, information on the spirometers, person requesting the spirometries and the location where these are carried out, quality control procedures performed, inclusion in hospital databases, information on the professionals carrying out and interpreting the tests, training received, etc. (<a class="elsevierStyleCrossRef" href="#sec0095">Appendix 1</a>).</p><p id="par0040" class="elsevierStylePara elsevierViewall">With regard to the location where the spirometry is carried out, for the purposes of this study, the “lung function laboratory” was defined as a set space identified as such in which at least one nursing professional regularly carried out spirometries, carbon monoxide diffusing capacity (DLCO) determinations and/or lung volumes.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Indicators</span><p id="par0045" class="elsevierStylePara elsevierViewall">The indicators calculated were as follows: number of spirometries per 100 hospital beds, per 100 discharges, per 100 outpatient consultations, per 100 emergency consultations and per 100 inhabitants. All were calculated for one year. Results were obtained overall and by healthcare region.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical Analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">A descriptive analysis was initially performed of the survey items for the whole of Catalonia, for each of the healthcare regions and for the healthcare sectors within the Barcelona healthcare region. The number of cases and frequencies of the categorical variables and central tendency statistics and dispersion of continuous variables were calculated. The variation ratio (VR) was used to describe the magnitude of the difference between regions. This is the ratio between the highest and lowest values of the rates for the complete set of regions studied. It is an indication of how much the region with the highest rate varies with respect to the region with the lowest rate.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The number of spirometries carried out in each hospital is distributed using a Poisson law. To explore the association between the number of spirometries carried out in each hospital and the various factors of the survey, a multilevel Poisson regression model was constructed, including the number of discharges from the hospital as the offset. The factors studied were the existence of a Respiratory Medicine department in the hospital, whether the patients admitted were seen by a pulmonologist, the number of lung function tests performed, the availability of a set location for performing spirometries, if there was quality control of the tests, the availability of a data system, formal training for professionals and if they had undergone that training in the last year. An association with a <span class="elsevierStyleItalic">P</span>-value of less than .05 was considered significant. The SPSS v18 programme was used for data management and the STATA v11 for the statistical analysis.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Responses</span><p id="par0060" class="elsevierStylePara elsevierViewall">All 65 hospitals in the Catalan public healthcare network completed the survey and it was determined that 8 of them, due to their specific specialist nature, did not carry out spirometries. The results presented below are derived from the 57 hospitals in which spirometries were carried out. The survey was piloted in three hospitals in Barcelona and Vic (in which the authors of the design are currently employed) to assess the feasibility of the items to be completed. Survey completion was the responsibility of the physicians in charge of each of the lung function laboratories, who in turn designated the professional who would complete the survey. We do not have data on their professional category and/or responsibilities.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Presence of a Pulmonologist</span><p id="par0065" class="elsevierStylePara elsevierViewall">In 34.5% (n=19) of the hospitals there was a Respiratory Medicine department, in 34.5% (n=19) there was a Respiratory Medicine section, 25.5% (n=14) had a consultant pulmonologist and 5.5% (n=3) did not have any of these three resources. Respiratory patients who were admitted were treated in 24.1% (n=13) of the cases primarily by pulmonologists, in 35.2% of cases (n=19) by internists and in the remaining 40.7% (n=22), care was shared between pulmonologists and internists.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Types of Tests</span><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the type of lung function tests that were carried out in the 57 hospitals in the study. Spirometry was carried out in all centres. In 85.9% (n=49) of the centres, at least three of these tests were carried out. Testing was performed in paediatric patients in all healthcare regions, but only in 67% of the hospitals (n=39). Spirometry was carried out in various locations in or outside the hospital that were not mutually exclusive: 47% (n=27) of the hospitals had a set location; of these, 37% (n=21) had a lung function laboratory as previously defined. Spirometry was also performed in other hospital settings: in 37% (n=21), they were performed in outpatient clinics, in 26% (n=15) in the day hospital, in 10% (n=17) in the conventional ward, in 7% (n=4) in the patient's home, in 14% (n=8) in the Respiratory Medicine ward and in 10% (n=17) in the general medicine ward.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Quality Control</span><p id="par0075" class="elsevierStylePara elsevierViewall">In all hospitals, the spirometer was calibrated, mainly by nursing or technical staff: 81% (n=43) nursing staff, 30% (n=16) technical staff and 17% (n=9) physicians, although in some cases the calibration was performed equally by different professionals. The interpretation of the tests depended on the organization of each centre. In 11% (n=6) of the cases, each doctor interpreted the tests that he/she had requested him/herself. In 87% (46%) of the hospitals, the tests were interpreted by pulmonologists and in 19% (n=10) by the internists as well. In 9% (n=5) of the centres, the results were interpreted by family doctors and in one hospital by the nursing staff.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Seventy-one percent (71%) (n=40) of the hospitals stated that they carried out quality control of the tests. Since the question allowed for an open answer, the centres responded in a varied manner. The most frequent responses were the use of healthy volunteers or professionals, direct supervision of the test or data obtained from the spirometry equipment itself and/or the visual analysis of the flow-volume curves.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In 35% (n=2 0), the information provided by the spirometry was available in the hospital data system: it was entered manually in 9 centres and automatically in 11. In 24.5% (n=13) of the hospitals, the precise contents of the spirometry report were transferred to the hospital database or clinical records. In 20.8% (n=11) of the cases, the spirometry data were not entered in an unbundled format (pdf format), so the data could not be individually manipulated, in only 7.5% (n=4) of the hospitals, the data were entered in an unbundled format, and the spirometry report in its entirety was incorporated in an unbundled format in 3.8% (n=2) of the hospitals.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Training of Professionals</span><p id="par0090" class="elsevierStylePara elsevierViewall">It was observed that only one hospital selected professionals with previous training, while in the majority of the centres (86.8%, n=46), professionals were selected and then received training. In 43.9% (n=25) of the hospitals, the professionals performing the spirometries received internal non-formal training and in 26.3% (n=15), they received internal formal training. When asked about what type of continuing education was given, 25% (n=14) only carried out training at the time the professionals were selected and 14% (n=8) carried out regular yearly training, while 59.6% (n=34) carried out training spontaneously. When asked how long it was since the professional involved in performing the spirometries had done a course, 14.8% (n=8) of the hospitals answered less than 3 months, 5.6% (n=3) between 3 and 6 months, 20.4% (n=11) less than one year, 24.1% (n=13) between 1 and 2 years and 35.2% (n=19), more than 2 years.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Request for Examinations</span><p id="par0095" class="elsevierStylePara elsevierViewall">The survey showed that of the professionals requesting spirometry, 57% (n=30) were the hospital pulmonologists, 18% (n=9) hospital internal medicine specialists, 11% (n=6) were other hospital physicians, 3% (n=2) pulmonologists from outside the hospital, 4% (n=2) were primary care physicians and 2% (n=1) doctors from other hospitals.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Distribution of the Number of Examinations</span><p id="par0100" class="elsevierStylePara elsevierViewall">The rate of spirometries per 100 hospital discharges/year was 14.97, with a VR of 1.82, indicating an 82% greater use of spirometry between the region with the highest rate compared to the region with the lowest rate. The rate of spirometries per 100 inhabitants/year was 1.32, with a VR of 1.53; <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the wide variability in the Barcelona healthcare region. This region was analyzed by healthcare sector, since it accounts for 67.8% of the whole population of Catalonia (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a> and <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the analysis of the association between the numbers of spirometries carried out in each centre and the different factors surveyed, using a multilevel Poisson regression model. Among the various factors investigated, a statistically significant association was observed between the existence of a Respiratory Medicine department at the site and the availability of a set location for performing spirometries. The presence of these factors in a centre increased the spirometry rate by 59% and 56%, respectively. This could explain part (8%) of the difference between the centres, although it remains considerable. In this respect, the median incidence rate ratio (MIRR) is interpreted in such a way that the mean increase in the rate of spirometries between any two centres is 98% in the empty model and 88% in the final model. This suggests wide variability between the rates per centre, as shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> and <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. In this figure, the points represent the spirometry rates in each centre logarithmized and centred at zero for better comparability.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">There was little homogeneity in the results of the hospital spirometry survey between the hospitals and healthcare regions of Catalonia with respect to the use of spirometry, which may be a contributory factor to the underdiagnosis<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,22</span></a> of respiratory diseases.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">In some studies, this heterogeneity has been attributed to factors such as accessibility to the test<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> or the physician not requesting the test. In our study, variability cannot be attributed to accessibility, since all the healthcare regions have the necessary infrastructure for performing spirometry. The variability may be explained by the existence or non-existence of a Respiratory Medicine department and by the availability of a set location for performing spirometries. These factors are associated with a greater number of spirometries. Having a Respiratory Medicine department implies the explicit recognition of the distribution of tasks within the centre. Accordingly, in view of the survey data, we suggest that the most important aspect is not the structure in itself (i.e. the existence of the department) but rather the explicit recognition of the importance of lung function testing. Some studies attribute the under-use of spirometry, compared to other tests such as echocardiograms, to the characteristics of the disease itself.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15,16,24</span></a> We have not identified an indicator that would allow us to determine the appropriate range for spirometries per discharge volume or per hospital bed or per 100 inhabitants, but we do consider that obtaining those results when beginning to design a master plan could provide us with our own indicator for evaluating results in the future, while not forgetting that this will always be a process indicator, rather than a results indicator.</p><p id="par0120" class="elsevierStylePara elsevierViewall">It is likely that the differences in use of spirometry in the hospitals can be explained by various factors, from those centred on the professionals themselves to organizational factors. Adherence to clinical practice guidelines by professionals<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> or the basic training of personnel caring for respiratory patients in the hospitals may alter the use of spirometry. Thus, as we show in our study, in hospitals which had a Respiratory Medicine department and a set location for carrying out spirometries, a greater number of spirometries were performed. This result confirms that significant work needs to be carried out by pulmonologists in all healthcare settings and systems to encourage the use of spirometry by other specialists and primary care physicians.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Spirometry is a test which depends highly on the professional performing it. The importance of the training of that professional at the time of carrying out the spirometry has been documented<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26–28</span></a> and this implies an organizational need for professionals who have already received training before accessing the lung function laboratory. The need for homogeneous, standardized, continuing education programmes accepted by all organizations in order to achieve high quality spirometry has also been demonstrated. Our survey highlights the lack of rigour in the area of continuing spirometry education, since at the time of selecting the professionals for carrying out spirometries, the majority of hospitals do not take into account prior training, and the training that is given is neither formal nor systematic.</p><p id="par0130" class="elsevierStylePara elsevierViewall">When the quality control of the spirometers is analyzed, the diversity of responses to an open question on how quality control is performed is remarkable. Telemedicine strategies could probably help improve this quality control and achieve an increase in quality spirometries.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> Another area needing improvement has also been detected, namely, access to spirometry data via the hospital data systems. To our understanding, it is crucial that spirometry is not left behind in the ongoing development of computerized clinical records.</p><p id="par0135" class="elsevierStylePara elsevierViewall">The evaluation of the other lung function tests demonstrates that all healthcare regions have access to complex lung function testing, except for Vall d’Aran, a healthcare region in the high mountains, which nevertheless, has well-established connections to the nearest healthcare area. It is also of note that the 6-minute walking test is not widely disseminated among all the hospitals, as might be expected from its ease of use<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> and its importance in the integral evaluation of COPD patients.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a></p><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Study Limitations</span><p id="par0140" class="elsevierStylePara elsevierViewall">The methodology used in this study was a survey. Although there are no methodological alternatives for conducting the study, the limitations of this information source must be taken into account. In this study, the primary care network was not assessed, but we have recently started a survey of all the public network health centres in Catalonia. Since no other regional, national or international studies have been published, we cannot compare our data with the existing literature. There is no indicator in the literature regarding the number of spirometries per inhabitant; accordingly, one of the objectives initially proposed with respect to the assessment of the variability of the results and a comparison with the literature could not be estimated. For this reason, the statistical and clinical relevance of spirometry rates per inhabitant and year was not evaluated.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Other limitations of the study could include the bias in information derived from the person completing the survey and the fact that the estimated rates could not be standardized for age and sex of the patients. Part of the variability observed could be explained by the different population structure of each healthcare area, as well as severity levels or different comorbidities.</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conclusions</span><p id="par0150" class="elsevierStylePara elsevierViewall">The analysis of the use of spirometry in the hospital setting has allowed us to: (a) define the existence of a Respiratory Medicine department and a set location for performing spirometries as factors related with the more frequent performance of these tests; (b) draw up a homogeneous, decentralized and “self-replicating” training programme for all healthcare regions in Catalonia, which would allow quality spirometry to be performed within constantly changing organisations<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>; (c) determine the need for the inclusion of spirometry in hospital databases (electronic clinical records), thus standardizing data transfer and promoting interoperability; and (d) set up spirometry quality control models using information and communication technology.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> It has also allowed us to determine an indicator for the use of forced spirometry in a population (0.98–1.53 spirometries per 100 inhabitants), which to our knowledge does not appear in the reviewed literature.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> These changes should impact both on the professionals themselves and on the organizational structures of the hospitals, and in all cases should guarantee access to quality spirometry for all clinicians, regardless of the healthcare level at which they work.</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Conflict of Interests</span><p id="par0155" class="elsevierStylePara elsevierViewall">There are no conflicts of interest or sources of funding.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres272952" "titulo" => array:6 [ 0 => "Abstract" 1 => "Background" 2 => "Objective" 3 => "Methods" 4 => "Results" 5 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec254935" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres272951" "titulo" => array:6 [ 0 => "Resumen" 1 => "Introducción" 2 => "Objetivo" 3 => "Método" 4 => "Resultados" 5 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec254936" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and Methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Survey" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Data" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Indicators" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical Analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Responses" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Presence of a Pulmonologist" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Types of Tests" ] 3 => array:2 [ "identificador" => "sec0055" "titulo" => "Quality Control" ] 4 => array:2 [ "identificador" => "sec0060" "titulo" => "Training of Professionals" ] 5 => array:2 [ "identificador" => "sec0065" "titulo" => "Request for Examinations" ] 6 => array:2 [ "identificador" => "sec0070" "titulo" => "Distribution of the Number of Examinations" ] ] ] 7 => array:3 [ "identificador" => "sec0075" "titulo" => "Discussion" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0080" "titulo" => "Study Limitations" ] ] ] 8 => array:2 [ "identificador" => "sec0085" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0090" "titulo" => "Conflict of Interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-08-07" "fechaAceptado" => "2012-12-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec254935" "palabras" => array:4 [ 0 => "Spirometry" 1 => "Quality control" 2 => "Underdiagnosis" 3 => "Standards" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec254936" "palabras" => array:4 [ 0 => "Espirometría forzada" 1 => "Control de calidad" 2 => "Infradiagnóstico" 3 => "Estándares" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Underdiagnosis is one of the problems with the greatest impact on respiratory disease management and requires specific interventions. Access to quality spirometry is especially important and is an objective of the Master Plan for Respiratory Diseases of the Department of Health of the <span class="elsevierStyleItalic">Generalitat de Catalunya</span>.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To determine the current use of spirometry at public hospitals in Catalonia, possible deficiencies and options for improvement.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional survey of 65 public hospitals in Catalonia in 2009. Descriptive analyses were developed for each public health-care region.</p> <span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A lack of uniformity was observed in the use of spirometry at the regional level (between 0.98 and 1.50 spirometries per 100 inhabitants). We identified two factors associated with a higher rate of spirometry: (i) the existence of a Respiratory Medicine Department at the hospital, and (ii) the existence of a set location to carry out spirometries. Several areas for improvement also were identified: quality control of the test itself, the inclusion of spirometry in electronic health-care records and continuing education programmes.</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The results of this study have identified areas for improvement in spirometry programmes.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Introducción</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El infradiagnóstico es uno de los problemas de mayor impacto en las enfermedades respiratorias y requiere intervenciones específicas. Una de ellas es tener acceso a una espirometría de calidad. Este es uno de los objetivos del Plan Director de Enfermedades Respiratorias del Departament de Salut de la Generalitat de Catalunya.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Conocer la utilización de la espirometría hospitalaria en Cataluña, y conocer los posibles déficits y las opciones de mejora.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Método</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal mediante una encuesta a los 65 hospitales públicos de Cataluña durante el año 2009. Se realizó un análisis descriptivo para cada región sanitaria.</p> <span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se observó una falta de homogeneidad en la utilización de la espirometría a nivel territorial (de 0,98 a 1,50 espirometrías por 100 habitantes). Se identificaron 2 factores que están asociados a una mayor tasa de espirometrías: la existencia de un servicio de neumología en el centro y disponer de una ubicación estable para realizar espirometrías. Como áreas de mejora se identificaron el control de calidad de la prueba, la inclusión en los sistemas hospitalarios de información y los programas de formación continuada.</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Los resultados de este estudio han permitido identificar las áreas de mejora para un programa a desarrollar.</p>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Roger N, et al. Encuesta de utilización de la función pulmonar en los hospitales públicos de Cataluña en 2009. Arch Bronconeumol. 2013;49:371–7.</p>" ] 1 => array:2 [ "etiqueta" => "◊" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">See <a class="elsevierStyleCrossRef" href="#sec0095">Appendix 1</a>.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0165" class="elsevierStylePara elsevierViewall">B. Avilés (Hospital de Palamós); F. Burgos (Hospital Clínic, Barcelona); J. Clotet (EAP Ponts, Lleida); J. Delclós (University of Texas School of Public Health, United States); J. Escarrabill (PDMAR, Agency for Health Information, Evaluation and Quality [AIAQS]); J. Giner (Hospital de la Santa Creu i Sant Pau, Barcelona); M.A. Llauger (EAP Encants, CAP Maragall, Barcelona); R. Hervàs (CAE Dr. Barraquer, Sant Adrià del Besòs, Barcelona); F. Martín (EAP Tarragona, CAP Jaume <span class="elsevierStyleSmallCaps">I</span>, Tarragona); C. Martín, A. Moreno (Hospital Vall d’Hebron, Barcelona); F. Moya (TIC Salut); N. Roger (Consorci Hospitalari de Vic); C. Rubies, T. Salas (Departament de Salut, Área TICs); E. Torrente (Agency for Health Information, Evaluation and Quality [AIAQS]).</p> <p id="par0170" class="elsevierStylePara elsevierViewall">PDMAR Steering Committee: J. Escarrabill (Agency for Health Information, Evaluation and Quality [AIAQS]); C. Hernández (Hospital Clínic, Barcelona); J. Jiménez (CatSalut, Barcelona); M.A. Llauger (EAP Encants, CAP Maragall, Barcelona); N. Roger (Consorci Hospitalari de Vic); A. Rosas (General Regulatory, Planning and Evaluation Directorate; Department of Health, Barcelona); E. Saltó (General Public Health Directorate, Barcelona); R. Tresserras (General Regulatory, Planning and Health Resources Directorate; Department of Health, Barcelona), E. Torrente (Agency for Health Information, Evaluation and Quality [AIAQS]).</p>" "etiqueta" => "Appendix 1" "titulo" => "Lung Function Group" "identificador" => "sec0095" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2605 "Ancho" => 3333 "Tamanyo" => 767773 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Spirometry rates per 100 inhabitants in the Barcelona healthcare region.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1144 "Ancho" => 1591 "Tamanyo" => 73514 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Spirometry rates per centre (Catalonia, 2009). The spirometry rate per centre for the whole of Catalonia and by healthcare region are presented on a logarithmic scale and centred on the mean to improve comparability. Each point represents a hospital centre. Bcn: Barcelona healthcare region; Cat: total Catalonia; Centre: Central healthcare region; Ebre: Terres de l’Ebre healthcare region; Girona: Girona healthcare region; Lleida: Lleida healthcare region; Piri: Alt Pirineu healthcare region; Tarra: Tarragona healthcare region.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">6MW: 6-minute walking test; Vol<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>Diffusion: volume<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>diffusion.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Healthcare region \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Vol<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>diffusion</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Bronchial provocation test</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">6MW</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Blood gases</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Effort</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alt Pirineu i Aran \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Barcelona \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Catalunya Central \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Girona \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lleida \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Camp de Tarragona \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Terres de l’Ebre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab392497.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Number and Percentage of Hospitals With Lung Function Testing in Each Healthcare Region. Catalonia, 2009.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "<span class="elsevierStyleItalic">Sources</span>: Spirometry Survey PDMAR, 2009, and CatSalut Central Insurance Registry, 2009." "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Healthcare region \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Spirometry rate/100 inhabitants/year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Spirometry rate/100 discharges/year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Spirometry rate/100 outpatient consultations declared<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>/year \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alt Pirineu i Aran \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.90 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Barcelona \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Catalunya Central \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Girona \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.08 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lleida \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.65 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Camp de Tarragona \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.87 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Terres de l’Ebre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.31 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab392499.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Data declared by the centres participating in the survey.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Spirometry Rate by Catalan Healthcare Regions. Catalonia, 2009.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">The Poisson regression model is used in studies with count variables in a unit of space or time, in this case the number of spirometries carried out in one year. The coefficients of the model are interpreted in terms of incidence rate ratio. Taking as an example the variable “Respiratory Medicine department”, the presence of this in a centre increases the spirometry incidence rate by 59%.</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">The empty model is presented first to show the reduction, both in terms of plausibility (log-likelihood) and the variance between centres, represented by the inclusion of the variables “Respiratory Medicine department” and “set location”.</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">The median incidence rate ratio (MIRR) represents the median distribution of the difference in spirometry rates between any 2 centres.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Estimator, standard error</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Empty model \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Final model \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Respiratory Medicine department \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.59 (0.33) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Set location \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.56 (0.30) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospital variance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.72 (0.07) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.66 (0.07) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Log likelihood \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">–409 986 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">–405 985 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MIRR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.88 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab392498.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Multilevel Poisson Model Between Number of Spirometries and Various Factors Surveyed.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:33 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.D. Lopez" 1 => "C.D. Mathers" 2 => "M. Ezzati" 3 => "D.T. Jamison" 4 => "C.J. Murray" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(06)68770-9" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2006" "volumen" => "367" "paginaInicial" => "1747" "paginaFinal" => "1757" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16731270" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Activitat assistencial de la xarxa sanitaria de Catalunya. Any 2009. Registre del Conjunt Bàsic Mínim de Dades (CMBD) CatSalut. Departament de Salut. Generalitat de Catalunya." ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global burden of COPD: systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.J. Halbert" 1 => "J.L. Natoli" 2 => "A. Gano" 3 => "E. Badamgarav" 4 => "A.S. Buist" 5 => "D.M. Mannino" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.06.00124605" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2006" "volumen" => "28" "paginaInicial" => "523" "paginaFinal" => "532" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16611654" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activities" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Miravitlles" 1 => "J.B. Soriano" 2 => "F. García-Río" 3 => "L. Muñoz" 4 => "E. Duran-Tauleria" 5 => "G. Sanchez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thx.2009.115725" "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2009" "volumen" => "64" "paginaInicial" => "863" "paginaFinal" => "868" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19553233" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.J. Soler-Cataluna" 1 => "M.A. Martinez-Garcia" 2 => "S.P. Roman" 3 => "E. Salcedo" 4 => "M. Navarro" 5 => "R. Ochando" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thx.2005.040527" "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2005" "volumen" => "60" "paginaInicial" => "925" "paginaFinal" => "931" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16055622" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Case fatality of COPD exacerbations: a meta-analysis and statistical modelling approach" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Hoogendoorn" 1 => "R.T. Hoogenveen" 2 => "M.P. Rutten-van Mölken" 3 => "J. Vestbo" 4 => "T.L. Feenstra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00043710" "Revista" => array:7 [ "tituloSerie" => "Eur Respir J" "fecha" => "2011" "volumen" => "37" "paginaInicial" => "508" "paginaFinal" => "515" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20595157" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673605630139" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mortality after hospitalization for COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Almagro" 1 => "E. Calbo" 2 => "A. Ochoa de Echagüen" 3 => "B. Barreiro" 4 => "S. Quintana" 5 => "J.L. Heredia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2002" "volumen" => "121" "paginaInicial" => "1441" "paginaFinal" => "1448" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12006426" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factors and outcomes associated with chronic obstructive pulmonary disease exacerbations requiring hospitalization" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K. Bahadori" 1 => "J.M. FitzGerald" 2 => "R.D. Levy" 3 => "T. Fera" 4 => "J. Swiston" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Can Respir J" "fecha" => "2009" "volumen" => "16" "paginaInicial" => "e43" "paginaFinal" => "e49" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19707601" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recent trends in COPD prevalence in Spain: a repeated cross-sectional survey 1997–2007" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.B. Soriano" 1 => "J. Ancochea" 2 => "M. Miravitlles" 3 => "F. García-Río" 4 => "E. Duran-Tauleria" 5 => "L. Muñoz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00138409" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2010" "volumen" => "36" "paginaInicial" => "758" "paginaFinal" => "765" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19996189" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and underdiagnosis of chronic obstructive pulmonary disease among patients at risk in primary care" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Hill" 1 => "R.S. Goldstein" 2 => "G.H. Guyatt" 3 => "M. Blouin" 4 => "W.C. Tan" 5 => "L.L. Davis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1503/cmaj.091784" "Revista" => array:6 [ "tituloSerie" => "CMAJ" "fecha" => "2010" "volumen" => "182" "paginaInicial" => "673" "paginaFinal" => "678" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20371646" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differences in COPD care among doctors who control the disease: general practitioner vs. pneumologist" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "EFRAM Investigators" "etal" => false "autores" => array:6 [ 0 => "J. Garcia-Aymerich" 1 => "J. Escarrabill" 2 => "R.M. Marrades" 3 => "E. Monsó" 4 => "E. Barreiro" 5 => "J.M. Antó" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2005.04.021" "Revista" => array:6 [ "tituloSerie" => "Respir Med" "fecha" => "2006" "volumen" => "100" "paginaInicial" => "332" "paginaFinal" => "339" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15939580" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "PLATINO Team" "etal" => true "autores" => array:6 [ 0 => "A.M. Menezes" 1 => "R. Perez-Padilla" 2 => "J.R. Jardim" 3 => "A. Muiño" 4 => "M.V. Lopez" 5 => "G. Valdivia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(05)67632-5" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2005" "volumen" => "366" "paginaInicial" => "1875" "paginaFinal" => "1881" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16310554" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multi-center survey of COPD in five major Latin American cities" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Menezes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "The Platino Survey" "fecha" => "2002" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Calidad del diagnóstico de enfermedad pulmonar obstructiva crónica en el ámbito hospitalario" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "en representación del Grupo EPOC de Sociedad Valenciana de Neumología" "etal" => false "autores" => array:4 [ 0 => "C. Pellicer Císcar" 1 => "J.J. Soler Cataluña" 2 => "A.L. Andreu Rodríguez" 3 => "J. Bueso Fabra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2009.10.012" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2010" "volumen" => "46" "paginaInicial" => "64" "paginaFinal" => "69" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20004051" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Discrepancy in the use of confirmatory tests in patients hospitalized with the diagnosis of chronic obstructive pulmonary disease or congestive heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Damarla" 1 => "B.R. Celli" 2 => "H.X. Mullerova" 3 => "V.M. Pinto-Plata" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Respir Care" "fecha" => "2006" "volumen" => "51" "paginaInicial" => "1120" "paginaFinal" => "1124" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17005056" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Screening for and early detection of chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.B. Soriano" 1 => "J. Zielinski" 2 => "D. Price" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(09)61290-3" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2009" "volumen" => "374" "paginaInicial" => "721" "paginaFinal" => "732" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19716965" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Uso de la espirometría versus ecocardiografía en pacientes hospitalizados por EPOC o insuficiencia cardíaca" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.J. Torrubia Fernandez" 1 => "A. Comin Orce" 2 => "M. Moreno Venris" 3 => "J. Carrizo Sierra" 4 => "J.M. Marin Trigo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Med Interna (Madrid)" "fecha" => "2008" "volumen" => "25" "paginaInicial" => "222" "paginaFinal" => "225" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Using targeted spirometry to reduce non-diagnosed chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Schirnhofer" 1 => "B. Lamprecht" 2 => "N. Firlei" 3 => "B. Kaiser" 4 => "A.S. Buist" 5 => "R.J. Halbert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000320251" "Revista" => array:6 [ "tituloSerie" => "Respiration" "fecha" => "2011" "volumen" => "81" "paginaInicial" => "476" "paginaFinal" => "482" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20720402" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "SUPPORT Tools for evidence-informed health Policymaking (STP) 13: preparing and using policy briefs to support evidence-informed policymaking" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.N. Lavis" 1 => "G. Permanand" 2 => "A.D. Oxman" 3 => "S. Lewin" 4 => "A. Fretheim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1478-4505-7-S1-S13" "Revista" => array:6 [ "tituloSerie" => "Health Res Policy Syst" "fecha" => "2009" "volumen" => "7" "numero" => "Suppl 1" "paginaInicial" => "S13" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20018103" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "SUPPORT Tools for evidence-informed health Policymaking (STP) 14: organising and using policy dialogues to support evidence-informed policymaking" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.N. Lavis" 1 => "J.A. Boyko" 2 => "A.D. Oxman" 3 => "S. Lewin" 4 => "A. Fretheim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1478-4505-7-S1-S14" "Revista" => array:6 [ "tituloSerie" => "Health Res Policy Syst" "fecha" => "2009" "volumen" => "7" "numero" => "Suppl 1" "paginaInicial" => "S14" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20018104" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Planificación según prioridades de salud. Criterios de planificación relacionados con los Planes Directores" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. Tresserras" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2008" "volumen" => "131" "numero" => "Supl 4" "paginaInicial" => "42" "paginaFinal" => "46" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diferencias geográficas en la prevalencia de EPOC en España: relación con hábito tabáquico, tasas de mortalidad y otros determinantes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.B. Soriano" 1 => "M. Miravitlles" 2 => "L. Borderías" 3 => "E. Duran-Tauleria" 4 => "F. García Río" 5 => "J. Martínez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2010.06.008" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2010" "volumen" => "46" "paginaInicial" => "522" "paginaFinal" => "530" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20832926" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early detection of COPD in general practice" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "TOP study group" "etal" => true "autores" => array:6 [ 0 => "C.S. Ulrik" 1 => "A. Løkke" 2 => "R. Dahl" 3 => "J. Dollerup" 4 => "G. Hansen" 5 => "P.H. Cording" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/COPD.S16929" "Revista" => array:6 [ "tituloSerie" => "Int J Chron Obstruct Pulmon Dis" "fecha" => "2011" "volumen" => "6" "paginaInicial" => "123" "paginaFinal" => "127" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21407825" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spirometry utilization for COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.K. Han" 1 => "M.G. Kim" 2 => "R. Mardon" 3 => "P. Renner" 4 => "S. Sullivan" 5 => "G.B. Diette" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.06-2846" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2007" "volumen" => "132" "paginaInicial" => "403" "paginaFinal" => "409" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17550936" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spirometry use in clinical practice following diagnosis of COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T.A. Lee" 1 => "B. Bartle" 2 => "K.B. Weiss" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.129.6.1509" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2006" "volumen" => "129" "paginaInicial" => "1509" "paginaFinal" => "1515" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16778268" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Workplace safety and health topics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Center for Disease Control and Prevention" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "titulo" => "Spirometry training" "fecha" => "2004" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "General considerations for lung function testing" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "ATS/ERS Task Force" "etal" => true "autores" => array:6 [ 0 => "M.R. Miller" 1 => "R. Crapo" 2 => "J. Hankinson" 3 => "V. Brusasco" 4 => "F. Burgos" 5 => "R. Casaburi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.05.00034505" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2005" "volumen" => "26" "paginaInicial" => "153" "paginaFinal" => "161" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15994402" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spirometry quality-control strategies in a multinational study of the prevalence of chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "PLATINO Group" "etal" => false "autores" => array:4 [ 0 => "R. Pérez-Padilla" 1 => "J.C. Vázquez-García" 2 => "M.N. Márquez" 3 => "A.M. Menezes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Respir Care" "fecha" => "2008" "volumen" => "53" "paginaInicial" => "1019" "paginaFinal" => "1026" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18655739" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Telemedicine enhances quality of forced spirometry in primary care" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "on behalf of e-Spir@p Group" "etal" => true "autores" => array:6 [ 0 => "F. Burgos" 1 => "C. Disdier" 2 => "E. Lopez de Santamaria" 3 => "B. Galdiz" 4 => "N. Roger" 5 => "M.L. Rivera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00168010" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2012" "volumen" => "39" "paginaInicial" => "1313" "paginaFinal" => "1318" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22075488" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Manual SEPAR de procedimientos n.° 4. Procedimientos de evaluación de la función pulmonar <span class="elsevierStyleSmallCaps">II</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Burgos" 1 => "P. Casan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2004" "editorial" => "Permanyer" "editorialLocalizacion" => "Barcelona" ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.R. Celli" 1 => "C.G. Cote" 2 => "J.M. Marin" 3 => "C. Casanova" 4 => "M. Montes de Oca" 5 => "R.A. Mendez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa021322" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2004" "volumen" => "350" "paginaInicial" => "1005" "paginaFinal" => "1012" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14999112" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diseño de un programa de formación básico para conseguir espirometrías de calidad" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "en nombre del Grupo de Función Pulmonar y del equipo directivo del PDMAR" "etal" => false "autores" => array:6 [ 0 => "J. Escarrabill" 1 => "N. Roger" 2 => "F. Burgos" 3 => "J. Giner" 4 => "A. Molins" 5 => "Tresserras R" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Educ Med" "fecha" => "2012" "volumen" => "15" "paginaInicial" => "103" "paginaFinal" => "107" ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A survey of practices of pulmonary function interpretation in laboratories in Northeast Ohio" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Mohanka" 1 => "K. McCarthy" 2 => "M. Xu" 3 => "J.K. Stoller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.11-1141" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2012" "volumen" => "141" "paginaInicial" => "1040" "paginaFinal" => "1046" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21940775" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "titulo" => "Acknowledgements" "texto" => "<p id="par0160" class="elsevierStylePara elsevierViewall">The authors would like to thank all the participating centres for the collaboration in data collection and Jordina Capella and Cristian Tebé Cordomí (Agency for Health Information, Evaluation and Quality of the Department of Health of the <span class="elsevierStyleItalic">Generalitat de Catalunya</span>) for their invaluable help with the statistical analysis of the data in this paper.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000004900000009/v1_201309020022/S1579212913001249/v1_201309020022/en/main.assets" "Apartado" => array:4 [ "identificador" => "9374" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000004900000009/v1_201309020022/S1579212913001249/v1_201309020022/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212913001249?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 2 | 9 |
| 2024 October | 71 | 28 | 99 |
| 2024 September | 59 | 23 | 82 |
| 2024 August | 75 | 45 | 120 |
| 2024 July | 84 | 26 | 110 |
| 2024 June | 59 | 30 | 89 |
| 2024 May | 108 | 26 | 134 |
| 2024 April | 26 | 23 | 49 |
| 2024 March | 35 | 17 | 52 |
| 2024 February | 35 | 31 | 66 |
| 2023 April | 1 | 0 | 1 |
| 2023 March | 13 | 3 | 16 |
| 2023 February | 57 | 17 | 74 |
| 2023 January | 38 | 37 | 75 |
| 2022 December | 72 | 39 | 111 |
| 2022 November | 50 | 22 | 72 |
| 2022 October | 38 | 44 | 82 |
| 2022 September | 19 | 28 | 47 |
| 2022 August | 40 | 53 | 93 |
| 2022 July | 27 | 42 | 69 |
| 2022 June | 23 | 31 | 54 |
| 2022 May | 35 | 48 | 83 |
| 2022 April | 29 | 26 | 55 |
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| 2022 February | 37 | 38 | 75 |
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| 2021 December | 37 | 37 | 74 |
| 2021 November | 42 | 50 | 92 |
| 2021 October | 30 | 41 | 71 |
| 2021 September | 27 | 45 | 72 |
| 2021 August | 26 | 27 | 53 |
| 2021 July | 28 | 36 | 64 |
| 2021 June | 28 | 38 | 66 |
| 2021 May | 54 | 48 | 102 |
| 2021 April | 42 | 64 | 106 |
| 2021 March | 34 | 25 | 59 |
| 2021 February | 13 | 25 | 38 |
| 2021 January | 19 | 15 | 34 |
| 2020 December | 23 | 14 | 37 |
| 2020 November | 14 | 13 | 27 |
| 2020 October | 21 | 13 | 34 |
| 2020 September | 22 | 18 | 40 |
| 2020 August | 27 | 14 | 41 |
| 2020 July | 37 | 22 | 59 |
| 2020 June | 21 | 2 | 23 |
| 2020 May | 25 | 13 | 38 |
| 2020 April | 31 | 24 | 55 |
| 2020 March | 23 | 7 | 30 |
| 2020 February | 25 | 21 | 46 |
| 2020 January | 30 | 24 | 54 |
| 2019 December | 42 | 19 | 61 |
| 2019 November | 36 | 18 | 54 |
| 2019 October | 29 | 10 | 39 |
| 2019 September | 13 | 6 | 19 |
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| 2019 July | 25 | 13 | 38 |
| 2019 June | 15 | 13 | 28 |
| 2019 May | 15 | 17 | 32 |
| 2019 April | 25 | 33 | 58 |
| 2019 March | 36 | 23 | 59 |
| 2019 February | 27 | 26 | 53 |
| 2019 January | 30 | 11 | 41 |
| 2018 December | 39 | 25 | 64 |
| 2018 November | 73 | 28 | 101 |
| 2018 October | 108 | 25 | 133 |
| 2018 September | 50 | 12 | 62 |
| 2018 May | 14 | 1 | 15 |
| 2018 April | 67 | 11 | 78 |
| 2018 March | 59 | 6 | 65 |
| 2018 February | 80 | 6 | 86 |
| 2018 January | 257 | 5 | 262 |
| 2017 December | 156 | 7 | 163 |
| 2017 November | 30 | 7 | 37 |
| 2017 October | 22 | 12 | 34 |
| 2017 September | 33 | 9 | 42 |
| 2017 August | 50 | 10 | 60 |
| 2017 July | 46 | 9 | 55 |
| 2017 June | 66 | 12 | 78 |
| 2017 May | 51 | 10 | 61 |
| 2017 April | 29 | 6 | 35 |
| 2017 March | 36 | 4 | 40 |
| 2017 February | 19 | 10 | 29 |
| 2017 January | 14 | 4 | 18 |
| 2016 December | 44 | 6 | 50 |
| 2016 November | 46 | 6 | 52 |
| 2016 October | 32 | 19 | 51 |
| 2016 September | 51 | 10 | 61 |
| 2016 August | 43 | 8 | 51 |
| 2016 July | 45 | 21 | 66 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 47 | 2 | 49 |
| 2015 September | 58 | 10 | 68 |
| 2015 August | 55 | 11 | 66 |
| 2015 July | 50 | 4 | 54 |
| 2015 June | 46 | 7 | 53 |
| 2015 May | 36 | 8 | 44 |
| 2015 April | 23 | 6 | 29 |
| 2015 March | 30 | 9 | 39 |
| 2015 February | 28 | 6 | 34 |
| 2015 January | 23 | 6 | 29 |
| 2014 December | 25 | 7 | 32 |
| 2014 November | 21 | 8 | 29 |
| 2014 October | 31 | 14 | 45 |
| 2014 September | 22 | 12 | 34 |
| 2014 August | 25 | 14 | 39 |
| 2014 July | 25 | 14 | 39 |
| 2014 June | 43 | 16 | 59 |
| 2014 May | 42 | 13 | 55 |
| 2014 April | 40 | 10 | 50 |
| 2014 March | 43 | 19 | 62 |
| 2014 February | 40 | 11 | 51 |
| 2014 January | 30 | 20 | 50 |
| 2013 December | 49 | 14 | 63 |
| 2013 October | 0 | 1 | 1 |
| 2013 September | 2 | 2 | 4 |
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